Provider Demographics
NPI:1134100431
Name:HOUSLEY, SUSAN GLEE (MSPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GLEE
Last Name:HOUSLEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-0190
Mailing Address - Country:US
Mailing Address - Phone:870-448-5732
Mailing Address - Fax:870-448-2514
Practice Address - Street 1:400 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:AR
Practice Address - Zip Code:72650-7884
Practice Address - Country:US
Practice Address - Phone:870-448-5732
Practice Address - Fax:870-448-2514
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 1757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129314721Medicaid
AR5T292OtherBCBS
AR046588OtherPTAN
AR30008565931OtherQUALCHOICE